Provider Demographics
NPI:1134446677
Name:MAGNUM HEALTH AND REHAB OF MONROE LLC
Entity type:Organization
Organization Name:MAGNUM HEALTH AND REHAB OF MONROE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-242-4848
Mailing Address - Street 1:1215 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3368
Mailing Address - Country:US
Mailing Address - Phone:734-242-4848
Mailing Address - Fax:734-242-2007
Practice Address - Street 1:1215 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3368
Practice Address - Country:US
Practice Address - Phone:734-242-4848
Practice Address - Fax:734-242-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5232OtherMEDICARE